Random Flashcards

Question

What are the symptoms of polymyositis? Pathologic features?

Answer 1

Proximal muscle weakness endomysial mononuclear infiltrate with patchy necrosis Anti-Jo-1 Over-expression of MHC I on sarcolemma, leading to CD8 myocyte damage

Answer 2

Inhibit calcineurin activation | normally, calcineurin-->NFAT-->IL-2-->growth and differentiation of T-cells

Answer 3

``` Calcinosis Raynaud's Esophageal dysmotility Sclerodactyly Telangiectasias ```

Answer 4

physical and mental retardation, megaloblastic anemia, and elevated urinary orotic acid

Answer 5

Rough endoplasmic reticulum

Answer 6

required cofactor for hydroxylation of collagen alpha chain proline and lysine in the RER

Answer 7

Close to the origin of the left subclavian artery

Answer 8

in the sinotubular junction

Answer 9

Oxidize Fe2+ to Fe3+ --> formation of methemoglobin that cannot bind O2. Also, allosteric effects such that affinity of the other Hgbs in the tetramer is increased, shifting the dissociation curve to the left

Answer 10

area under the oral curve divided by area under the ive curve (graph of plasma concentration over time)

Answer 11

via the vertebral venous plexus, which communicates with the prostatic venous plexus (prostate, penis, and bladder). This can also lead to brain metastases, because it runs straight to the brain

Answer 12

Pseudomonas

Answer 13

Macrophages- This leads to release of cytokines, platelet-derived GF, and insulin-like GF --> stimulate fibroblasts-->progressive interstitial lung fibrosis

Answer 14

Small cell lung cancer | Neuroendocrine markers: Neural cell adhesion molecule, neuron-specific enolase, chromogranin, and synaptophysin.

Answer 15

Cardiac arrhythmia- TCAs inhibit fast sodium channel conduction, leading to slow myocardial depolarization. Can also lead to refractory hypotension and peripheral vasodilation (alpha 1 adrenergic receptor antagonism)

Answer 16

Valproate, Quetiapine, and lithium

Answer 17

UGT (uridine diphosphate glucuronyltransferase), which conjugates bilirubin with glucuronic acid.

Answer 18

bilirubin encephalopathy- potentially fatal, severe jaundice, neurologic impairment

Answer 19

AV node refractory period

Answer 20

junctional nevi- limited to the dermoepidermal junction. Flat pigmented macules compound nevi- nevus extends into dermis. Raised papules Intradermal- older. lost the epidermal nests. skin to tan colored dome-shaped

Answer 21

Toxic Megacolon | Abdominal x-ray

Answer 22

ab pain/distention, fever, bloody diarrhea, signs of shock

Answer 23

Decreased cholecystokinin release due to lack of enteral stimulation leads to reduced biliary contraction and biliary stasis.

Answer 24

upper glandular layer of the gastric body and fundus. | They secrete gastric acid and intrinsic factor

Answer 25

Midline defects: holoprosencephaly, microcephaly, micropthalmia, cleft palate, omphalocele, polydactyly, and cutis aplasia

Answer 26

CD40L: XLR Most common CD40: AR

Answer 27

Trypsinogen is activated to trypsin by enteropeptidases in the brush border of the duodenum. Trypsin then activates chymotrypsinogen, procarboxypeptidase, and proelastase.

Answer 28

Protein and fat malabsorption --> diarrhea, failure to thrive, edema

Answer 29

uroporphyrinogen decarboxylase

Answer 30

uroporphyrinogen decarboxylase, coprophyrinogen oxidase, protoporphyrinogen oxidase, or ferrochelatase

Answer 31

Defective DNA mismatch repair | MSH (MutS) & MLH1 (MutL)

Answer 32

involvement of the suspensory ligaments of the breast.

Answer 33

As an irregularly shaped adherent breast mass

Answer 34

degenerative arthritis of the spine results in narrowing of the spinal canal due to intervertebral disc herniation, ligamentum flavum hypertorphy, and osteophyte formation

Answer 35

posture-dependent lower extremity pain, numbness/paresthesia, and weakness. Worse with standing up, better with leaning or walking uphill

Answer 36

Vit D analogs- calcipotriol, calcitriol, and tacalcitol Vit D receptor is a nuclear transcription factor that causes inhibition of keratinocyte proliferation and stimulation of keratinocyte differentiation

Answer 37

flu-like febrile illness with MARKED MYALGIAS and JOINT PAIN, retro-orbital pain, rash Hemorrhagic: thrombocytopenia, spontaneous bleeding- shock

Answer 38

Exposure to a different serotype after primary exposure. May be due to Ab dependent enhancement of infection, enhanced immune complex formation, and/or accelerated Tcell response

Answer 39

Skin, liver, GI Usually starts with maculopapular rash on the soles and palms Abnormal LFTs diarrhea, intestinal bleeding, ab pain

Answer 40

E Coli, Enterococcus, Klebsiella, Enterobacter

Answer 41

H flu type b- MENINGITIS, pneumonia, epiglottitis, and sepsis

Answer 42

Chvostek: muscle contraction elicited by tapping on the facial nerve. Trousseau: Carpopedal spasm with polonged inflation of a blood pressure cuff around the arm

Answer 43

injury to the parathyroids during thyroid surgery

Answer 44

monoclonal Ab against the CD 20 surface Ig on B cells (lymphoma)

Answer 45

chimeric IgG1 against TNF-alpha (RA, Ankylosing spondylitis, fistulizing Crohn's)

Answer 46

It regulates activation and differentiation of t cells to aid in tumor destruction

Answer 47

Pyrrolidonyl arylamidase test (PYR +)

Answer 48

More indolent Prostate cancer small cell lung Hodkin lymphoma

Answer 49

``` Aggressive Multiple myelome non-small cell lung non-Hodgkin lymphoma renal cell carcinoma melanoma ```

Answer 50

GI | Breast

Answer 51

Nitrate-free interval is to prevent tolerance

Answer 52

Endometrial carcinoma- imbalance of estrogen and progesterone, because there isn't a monthly dominant follicle to produce progesterone

Answer 53

Claudins, occludin

Answer 54

Cadherins (desmogleins, desmoplakin)

Answer 55

dorsal: inferior parathyroids ventral: thymus

Answer 56

Middle ear cavity, eustachian tube, mastoid air cells

Answer 57

Epithelial lining of the palatine tonsil

Answer 58

Dorsal: superior parathyroid Ventral: ultimobranchial body and Thyroid parafollicular (C) cells

Answer 59

human placental lactogen

Answer 60

G:C --> T:A transversion in codon 249 of the p53 gene

Answer 61

AV nodal cells

Answer 62

iliohypogastric

Answer 63

genitofemoral

Answer 64

ilioinguinal

Answer 65

Lateral femoral cutaneous

Answer 66

Obturator nerve

Answer 67

Bowel obstruction with ab pain/distention, N/V, there may be gas in the gallbladder and biliary tree A large gallstone causes formation of a cholecystenteric fistula b/w gallbladder and small intestine. Gallstone travels freely until it gets stuck in the ileum

Answer 68

Amatoxins are in poisonous mushrooms and get concentrated in the liver where they bind DNA-dependent RNA pol II and halt mRNA synthesis, ultimately resulting in apoptosis Symptoms: ab pain, vomiting, sever, cholera-like diarrhea- can lead to acute hepatic and renal failure

Answer 69

Necessary for G3P-->1,3 BPG Aerobic: during TCA cycle Anaerobic: Conversion of pyruvate to lactate by lactate dehydrogenase Without recovery of NADH, glycolysis cannot continue

Answer 70

Bleeding in the gut leads to breakdown of Hgb, which produces ammonia that is absorbed into the blood stream. If the patient has impaired liver function, they will not be able to detoxify this ammonia to urea

Answer 71

Candida Albicans: patches of adherent, grey/white pseudomembranes on erythematous mucosa HSV-1: Small vesicles--> punched out ulcers CMV: Linear ulcerations

Answer 72

Internal iliac arteries | No, because there is collateral blood supply to the uterus from the ovarian arteries

Answer 73

Bacterial production of aminoglycoside modifying enzymes | Acquired from transposon or plasmid

Answer 74

Alpha 1&2, and Beta 1 | NOT Beta 2 (No bronchodilation or vasodilation)

Answer 75

developed countries: Bacterial infection (Staph A)- Can gain access via biliary tract infection, portal vein pyemia, hepatic artery, Direct invasion from adjacent source, or penetrating trauma Undeveloped countries: Parasitic infection (Entamoeba histolytica, echinoccocal)

Answer 76

intraductal papilloma- proliferation o papillary cells in a duct or cyst with fibrovascular core

Answer 77

Rasburicase is a recombinant version of urate oxidase, which converts uric acid into allontoin. Allantoin is 5-10x more soluble in urine than uric acid

Answer 78

oxidase +, gram -, comma-shaped organism that grows on high-alkaline selective media

Answer 79

Salmonella Typhi

Answer 80

antibodies to hemagglutinin

Answer 81

superficial candida infection: T-cells | Hematogenous spread: Neutrophils

Answer 82

micrognathia, low-set ears, prominent occiput, hypertonia, clenched fists with overlapping fingers, Cardiac, genitourinary, and GI anomalies

Answer 83

dependent locations: | Superior regions of the lower lobe and posterior regions of the upper lobes

Answer 84

chorioretinitis, sensorineural deafness, seizures, jaundice, hepatomegaly, splenomegaly, and microcephaly

Answer 85

Mandibular

Answer 86

Produced by activated Tcells and NK cells in response to IL-12 from macrophages, IFN-gamma stimulates macrophages to kill phagocytosed pathogens

Answer 87

Measure response of Tcells when exposed to TB antigens

Answer 88

VHL, RET (MEN2), NF1

Answer 89

The chromaffin cells of the adrenal medulla

Answer 90

Aortic regurgitation: head bobbing from widened pulse pressure nocturnal palpitations from forceful ventricular contractions ejecting large stroke volumes

Answer 91

Converts 7-dehydrocholesterol (provitamin D3) to cholecalciferol (D3)

Answer 92

abnormal placental vasculature--> hypoxic placenta--> release of antiangiogenic factors--> endothelial injury--> increased permeability (proteinuria) and dysregulation of vascular tone (hypertension)

Answer 93

X-linked de novo mutation in the MECP2 gene Normal development until 5-18 months followed by a loss of motor and language skills, stereotypic hand movements, deceleration of head growth, seizures, ID

Answer 94

Presence of endometrial glandular tissue in the myometrium, usually in middle-aged parous females Presents with heavy menstrual bleeding, dysmenorrhea, and uniformly enlarged uterus

Answer 95

Meckel diverticulum due to incomplete obliteration of the omphalomesenteric duct that connects the midgut lumen and yolk sac cavity (rule of 2s). Can contain ectopic tissue- most often gastric epithelium producing acid that ulcerates neighboring tissue and causes painless melena

Answer 96

lymphocytic inflammation with destruction of intrahepatic bile ducts

Answer 97

liver failure with centrilobular necrosis that can extend to the entire lobe

Answer 98

hepatocellular swelling and necrosis, mallory bodies, neutrophilic infiltration, and fibrosis

Answer 99

Clot at the junction of hepatic vein and IVC causes increased intrahepatic pressure--> reddish-purple parenchyma with severe centrilobular congestion and necrosis

Answer 100

thromboembolic events, hypertension

Answer 101

In addition to upregulating PPAR alpha, they inhibit cholesterol 7 alpha hydroxylase, which catalyzes the last step in bile acid formation. The reduced bile acid production results in decreased cholesterol solubility.

Answer 102

Thiamine, Lipoate, Coenzyme A, FAD, NAD High dose thiamine can help improve MSUD

Answer 103

Inferior vena cava or hepatic veins

Answer 104

Brunner glands Epithelial cells of the pancreatic ductules and ducts produce water secretions containing high concentrates of bicarbonate ions

Answer 105

Advanced congestive heart failure

Answer 106

``` Resistant PBPs: -Listeria -MRSA -Enterococci No cell wall -Atypicals (mycoplasma, chlamydia) ```

Answer 107

Trastuzumab- binds HER2 and prevents activation of a transmembrane tyrosine kinase

Answer 108

Members of the Bacillus and Clostridium genuses

Answer 109

E6 binds p53, leading to ubiquitination--> can't halt cell cycle E7 binds Rb and displaces bound transcription factors, promoting unregulated DNA replication and cylcin-mediated cell cycling

Answer 110

Cortical fibers that run in the periventricular pathways get distended, leading to disruption of impulses from the cortex to the sacral micturition center

Answer 111

60% of ingested Cu is absorbed in the stomach and duodenum. It is made into ceruloplasmin in the liver, which is secreted into the plasma. Senescent ceruloplasmin and the unabsorbed Cu (40%) are secreted into bile and excreted in stool. About 5-15% of daily Cu excretion is from the kidney

Answer 112

X factor (hematin) and V factor (NAD+)

Answer 113

Spina Bifida, cleft lip and palate, DM, coronary artery disease, and HTN

Answer 114

Demargination of neutrophils previously attached to the vessel wall

Answer 115

Gout, because there will be increased purine and pyrimidine production, leading to increased degradation and hyperuricemia

Answer 116

Neutrophils

Answer 117

Renal artery

Answer 118

Superior vesical artery. | Circulation to the middle ureter is anastomotic and variable

Answer 119

primary erythematous lesion followed by tender regional lymphadenopathy Bacilliary Angiomatosis- red-purple papular skin lesions that may also be found within the viscera. Can be fatal if left untreated.

Answer 120

O antigen, core polysaccharide, and lipid A | Lipid A induces shock by activation of macrophages and granulocytes

Answer 121

para-aortic lymph nodes

Answer 122

RSV | less than 2 y/o

Answer 123

Short-acting: triazolam, oxazepam, midazolam | Intermediate-acting: lorazepam, alprazolam

Answer 124

Arginine (+NADPH and O2) | eNOS (epithelial nitric oxide synthase)

Answer 125

Activates Guanylyl cyclase--> increased cGMP, which activates protein kinase G and leads to a reduction in cytosolic Ca level

Answer 126

promotes follicular epidermal hyperproliferation and excessive sebum production

Answer 127

Ethylene glycol poisoning causing toxic renal injury and acute tubular necrosis

Answer 128

Normal glomeruli, but proximal tubular necrosis with cell ballooning and vacuolar degeneration

Answer 129

Osteosarcoma, | They also are at high risk for other types of sarcoma

Answer 130

Tumor suppressor, active when dephosphorylated, does not allow cell to proceed from G1 to S Phosphorylation of Rb permits cell division

Answer 131

Down Syndrome, Ataxia Telangiectasia, and NF1

Answer 132

``` Prematurity, low birth weight SIDS Middle ear disease Asthma Respiratory tract infections ```

Answer 133

hamartoma: well-defined coin lesion with "popcorn calcifications"

Answer 134

ovary: Simple cuboidal fallopian tube: Simple columnar- ciliated cells transport egg/embryo uterus: Simple columnar- prolonged estrogen prevents shedding--> hyperplasia/malignancy Endocervix: Simple columnar Ectocervix: Stratified squamous non-keratinized vagina: Stratified squamous non-keratinized- maintains acidic environment

Answer 135

myopathy, cardiomyopathy, hypoketotic hypoglycemia, decreased muscle carnitine content

Answer 136

Needed to shuttle fatty acids from the cytoplasm into the mitochondria during fatty acid oxidation. Therefore muscles can't use fats for ATP generation, and liver can't synthesize ketone bodies (acetoacetate) when glucose levels are low

Answer 137

Failure of bone marrow pre-B cells to mature, leading to low or absent B cell levels and pan hypoglobulinemia

Answer 138

dyregulated cell-mediated immune response to unknown antigen driven by macrophages and Th1: IL-2 and IFN-gamma. Promote formation of non-caseating granulomas

Answer 139

Cholecystokinin- made in duodenum and jejunum in response to fatty acids and amino acids

Answer 140

mRNA (produce complementary cDNA with the exons nad 5' and 3' untranslated regions)

Answer 141

Typically arise secondary to bacterial or helminthic infections that result in the release of beta-glucuronidase from injured hepatocytes and bacteria. The beta-glucuronidase hydrolyzes bilirubin glucuronides and leads to increased unconjugated bilirubin

Answer 142

Koilocytes- immature squamous cell with dense, irregularly staining cytoplasm and perinuclear clearing, resulting in a halo. "raisinoid" appearance of the the enlarged pyknotic nucleus

Answer 143

inferior hypogastric plexus

Answer 144

Pelvic splanchnic nerve (S2-4)

Answer 145

Motor function to the gluteus maximus

Answer 146

Sudan III stain of the the stool to check for fat

Answer 147

Shrunken due to rapid atrophy with widespread centrilobular necrosis and inflammation to the portal tracts and parenchyma (same as fulminant hepatitis) Halothane, but also enflurane, isoflurane, desflurane, and sevoflurane

Answer 148

fever, anorexia, nausea, myalgia, tender hepatomegaly, and jaundice Elevated LFTs, Prolonged PT, leukocytosis, and eosinophilia

Answer 149

low frequency tinnitus with a feeling of fullness Vertigo Sensorineural hearing loss

Answer 150

Defective resorption of endolymph and resultant increase in volume and pressure of endolymph, causing damage to the vestibular and cochlear components of the inner ear

Answer 151

Gastroesophageal junction incompetence

Answer 152

Distal esophagus with basal zone hyperplasia, elongation of the lamina propria papillae, and scattered eosinophils and neutrophils

Answer 153

It pulls the golgi tendon organ, which uses 1b sensory axons to contact inhibitory interneurons that synapse with the alpha motor neurons from that group--> relaxation

Answer 154

Activates the intrafusal fibers of the muscle spindle, leading to contraction--> deep tendon reflex

Answer 155

inactivate 60s ribosomal subunit in human cells

Answer 156

``` androgenetic alopecia epilepsy glaucoma HTN Ischemic hrt dz schizophrenia T2DM ```

Answer 157

fail to pass meconium within 48 hours bilious vomiting, ab distention empty rectal vault increased anal sphincter tone

Answer 158

doxycycline | penicillin-type antibodies (ceftriaxone)

Answer 159

High RBC turnover rate means there is a shorter period of exposure to high glucose levels Look for elevated HbA2 to diagnose beta thalassemia

Answer 160

Exfoliatin- cleaves desmoglein in desmosomes (only in epidermis) Skin slips off with gentle pressure, epidermal necrolysis, fever, and pain (bullous impetigo is a more localized form of SSSS)

Answer 161

Stratified squamous epithelium | anal canal, vagina, cervix, and the true vocal cords in the respiratory tract

Answer 162

Sickle cell dz--> thrombotic occlusion Vasculitis--> impaired blood supply Corticosteroids and alcohol--> unknown mechanism

Answer 163

DM Necrolytic migratory erythema: Erythematous papules/plaques on face, perineum, extremities. The lesions enlarge and coalesce, leaving a bronze-colored, central indurated area with peripheral blisters and scaling

Answer 164

Purkinje>Atrial>Ventricular>AV node

Answer 165

glycolysis, fatty acid synthesis, and the pentose phosphate pathway

Answer 166

beta-oxidation of fatty acids, TCA cycle, and carboxylation of pyruvate

Answer 167

Stress hormone induces release of hormone sensitive lipase in adipose tissue, which catalyzaes the mobilization of TGs into FFAs and glycerol. Glycerol is a source of Cs for gluconeogenesis and FAs are used to make Acetyl CoA for the TCA cycle or further metabolized into ketone bodies

Answer 168

Ureter, because it is just deep to the where the uterine vessels are ligated and the closure of the lateral aspect of the vaginal cuff--> can be sutured shut by accident

Answer 169

Duodenal atresia (failure of the recanalization of the duodenum in early gestation) Double bubble sign and bilious emesis Other GI issues: imperforate anus, Hirschsprung dz, TE fistula, and celiac dz

Answer 170

Generalized anxiety disorder partial agonist of the 5HT1A receptor Slow onset of action

Answer 171

``` HSV: shallow ulcerations with erythematous base Haemophilus ducreyi (chancroid): deep, purulent, painful ulcers with suppurative lymphadenitis Klebsiella granulomatis (granuloma inguinale): painless, progressive, red serpiginous ulcerative lesions without lymphadenopathy Chlamydia trachomatis (lymphogranuloma venereum): Initially painless small and shallow ulcers, followed by large painful coalesced lymph nodes, intracytoplasmic chlamydial inclusion bodies in epithelia cells and leukocytes ```

Answer 172

incomplete closure of the umbilical ring--> linea alba not formed. Most resolve spontaneously. Associated with Downs, Hypothyroidism, and Beckwith-Wiedemann syndrome

Answer 173

S. Pyogenes, S. Aureus, C. perfringens, and polymicrobial

Answer 174

Hyaluronidase- spread through skin and fascia M protein- evades phagocytosis by preventing activation of the alternative complement pathway Hemolysins O and S- hemolysis Pyrogenic exotoxin: superantigen--> tissue injury and septic shock

Answer 175

Occipital cortex - posterior cerebral artery The macula is spared because there is collateral blood flow from the middle cerebral artery to the occipital pole, which processes central visual info

Answer 176

Reactive arthritis is caused by immune complex deposition with bacterial antigens, though it is not a disseminated infection- taps are sterile. It most commonly follows infection with campylobacter, shigella, salmonella, Yersinia, CT, or Bartonella

Answer 177

conjunctivitis, urethritis, and keratoderma blennorrhagicum | HLA-B27

Answer 178

BMI, fasting glucose and lipids, BP, waist circumference

Answer 179

binds intracellular tubulin and inhibits its polymerization- This disrupts functions such as chemotaxis, phagocytosis, and degranulation. Colchicine also reduces formation of LTB4 Used during gout flare when NSAIDs are contraindication

Answer 180

Complete: diffuse trophoblastic proliferation and edematous chorionic villi (bunch of grapes)- no fetal tissue. p57-negative Partial: Some enlarge villi with focal trophoblastic proliferation. p57-positive

Answer 181

Galactokinase deficiency prevents galactose from being converted into galactose 1 phosphate. Instead, it is converted by aldose reductase into galactitol that is an osmotic agent and causes cataracts

Answer 182

excess galactose spills into urine, causing it to test positive for a reducing substance

Answer 183

GALT is much more severe due to buildup of toxic galactose-1-phosphate, which causes hepatic and renal dysfunction. It presents in neonates as vomiting, lethargy, and failure to thrive.

Answer 184

ileocecal junction | Barium enema is used for diagnosis, but can also be the treatment- if it doesn't work, then surgery

Answer 185

Osteoprotegerin to RANK-L | Low ratio means more bone being resorbed

Answer 186

NSAIDs uncouple oxidative phosphorylation and deplete glutathione, leading to lipid peroxidation--> damage to tubular and vascular endothelial cells Also leads to ischemic papillary necrosis via constriction of the medullary vasa recta

Answer 187

patchy interstitial inflammation--> fibrosis, tubular atrophy, papillary necrosis and scarring, and caliceal architecture destruction

Answer 188

With aromatase deficiency, the mom will undergo virilization (hirsutism) during the pregnancy

Answer 189

Krukenberg tumor | unintentional weight loss, epigastric pain, and adnexal masses

Answer 190

Signet ring cell- large amount of mucin displacing the nucleus

Answer 191

lymphatic invasion and peritoneal seeding

Answer 192

In patients with bilateral renal artery stenosis- they depend on the vasoconstriction from Ang II to maintain GFR

Answer 193

Distal convoluted tubule, because solutes are still being reabsorbed, but it is relatively impermeable to water, so the water can't be reabsorbed

Answer 194

Conversion of tyrosine to DOPA by tyrosine hydroxylase

Answer 195

DOPA decarboxylase

Answer 196

Dopamine beta-hydroxylase

Answer 197

Phenylethanolamine-N-Methyltransferase (PNMT) in the adrenal medulla. Upregulated by cortisol, so decreased cortisol/ACTH can lead to decreased conversion of Norepi to Epi

Answer 198

1. Osteolytic (osteoclast) 2. Mixed Osteoclastic-Osteoblastic: abnormal bone formation with areas of disorganized lamella and woven bone 3. Osteosclerotic (Osteoblast): remodeling--> dense, hypovascular mosaic pattern of lamellar bone with prominent cement lines

Answer 199

Alpha subunit exposes a Phospholipase C site theat hydrolyzes PIP2 into DAG and IP3. DAG stimulates PKC and IP3 releases intracellular Ca stores leading to even more PKC stimulation

Answer 200

Can present with both otologic symptoms and jaw pain, because the mandibular division of CN V innervates the middle ear and the muscles of mastication

Answer 201

Medial circumflex artery | Damage from fracures of the femoral neck

Answer 202

Splenic vein to the portal circulation rather than going straight back to systemic circulation

Answer 203

Arsenic poisoning ab pain, vomiting, severe watery diarrhea, delirium, and hypotension Prolonged QTc--> Torsades de Pointes Garlic odor on patient's breath or stool

Answer 204

Binds sulfhydryl groups, impairing cellular respiration via inhibition of pyruvate dehydrogenase and diruption of gluconeogensis and glutathione metabolism. Tx: Dimercaprol- chelating agent increases urinary excretion

Answer 205

Common complication of acute pancreatitis with collection of fluid rich in enzymes and inflammatory debris. The walls are lined by granulation tissue and fibrosis (unlike true cysts, which are lined by epithelium)

Answer 206

C3b and IgG | mannose-binding lectin and CRP can also opsonize

Answer 207

Polymyalgia Rheumatica

Answer 208

scattered, focal granulomatous inflammation centered on the media with intimal thickening, elastic lamina fragmentation, and giant cell formation

Answer 209

Sx: intermittent episodes of ab pain, peripheral neuropathy, renal insufficiency, and severe HTN Histology: Transmural inflammation of the arterial wall with fibrinoid necrosis

Answer 210

serum-sickness like syndrome with joint pain, lymphadenopathy, and a puriritic urticarial rash Can also have RUQ pain, hepatomegaly, and elevated LFTs

Answer 211

Transverse portion of the duodenum

Answer 212

disulfiram-like inhibition of acetaldehyde dehydrogenase causes buildup of acetaldehyde

Answer 213

Albinism, because tyrosinase is necessary to synthesize melanin from tyrosine

Answer 214

Phenylalanine Hydroxylase | Dihydrobiopterin reductase: worse, because also can't convert tyrosine into dopa, so can't form NE, EPI,DA, or 5HT

Answer 215

Decrease in fatty acid oxidation due to excess nADH production by alcohol dehydrogenase and aldehyde dehydrogenase

Answer 216

Brief: >1 day and <1 month Schizophreniform: >1 month and <6 months- doesn't require functional decline Schizophrenia: >6 months requires functional decline

Answer 217

Stem cell transplant

Answer 218

Macrophages, CD4 and CD8 tcells. Macrophages present to CD4, which recruit CD8 to produce the characteristic signs of induration and edema

Answer 219

Aniline dyes (methylene blue)

Answer 220

AR inactivating mutation of the neutral amino acid transporter in the small intestine and kidney. This leads to tryptophan (essential a.a.) deficiency. Tryptophan is a precursor for Niacin, serotonin, and melatonin

Answer 221

Excessive neutral amino acids in urine | Treated with a high protein diet and daily niacin or nicotinamide supplementation

Answer 222

Increased cGMP- Nitrates enhance synthesis and PDEs prevent degradation

Answer 223

From the posterior vaginal opening to the perineal body

Answer 224

CN IX, X, XI, and jugular vein

Answer 225

Decidualization- dilated, coiled endometrial glands and vascularized edematous stroma, prepared for implantation NO embryonic or trophoblastic tissue

Answer 226

Sertoli cells produce inhibin in response FSH. Inhibin then has negative feedback on FSH

Answer 227

Pasteurella

Answer 228

muscle weakness, cramps, paresthesias and possible rhabdomyolysis

Answer 229

Brain, Kidney, Intestine, Liver, RBCs

Answer 230

Muscle cells, adipocytes

Answer 231

S. Aureus or mixed oral aerobes/anaerobes Risk factors: dehydration, intubation, anticholinergics (decrease salivary flow), salivary flow obstruction, intense teeth cleaning

Answer 232

firm and erythematous pre/postauricular swelling that extends to the mandible Elevated amylase without pancreatitis

Answer 233

Acts as a progesterone antagonist that binds progesterone receptors with greater affinity. Progesterone blockade results in apoptosis and necrosis of the uterine decidua

Answer 234

AMH and Androgen binding protein

Answer 235

non-caseating granuloma: aggregates of epithelioid cells (activated macrophages) and multinucleated giant cells

Answer 236

IL-6- antibody against IL-6 (tocilizumab) is effective in treating GCA

Answer 237

Prostatic plexus Erectile dysfunction Preserve the integrity of the prostatic fascial shell during surgery

Answer 238

small to medium vessel vasculitis with late-onset asthma, rhinosinusitis, and eosinophilia Mononeuritis multiplex due to involvement of the epineural vessels of peripheral nerves is common

Answer 239

low-grade fever, anorexia/nausea, dark-colored urine RUQ pain

Answer 240

Hepatocyte necrosis characterized by cellular swelling and cytoplasmic emptying Hepatocyte apoptosis characterized by cellular shrinkage and nuclear fragmentation with intense eosinophilia

Answer 241

They extend cytoplasmic processes through the canaliculi to create gap junctions

Answer 242

The stereociliated hair cells in the organ of corti

Answer 243

stapedius (facial nerve) and tensor tympani

Answer 244

Unilateral high-frequency sensorineural hearing loss

Answer 245

Only affects air conduction across all frequencies

Answer 246

unilateral conductive hearing loss

Answer 247

Streak ovaries primarily composed of connective tissue with no follicles (usually lost by age 2)

Answer 248

Carbamazepine | reduces the ability of sodium channels to recover from inactivation

Answer 249

Bone marrow suppression- monitor CBC

Answer 250

NOD2 mutation- reduces NF-KB pathway activity -->reduced cytokine activation--> decreased mucosal defenses, so bacteria can invade further and cause a more robust inflammatory response from the adaptive immune system

Answer 251

Respiratory due to limited chest wall expansion Ascending aortitis--> dilation of the aortic ring and aortic insufficiency Anterior uveitis: pain, blurred vision, photophobi

Answer 252

Actinomyces israelii | "sulfur granules"- yellow aggregations of organisms bound together by proteins

Answer 253

Superficial peroneal | Deep peroneal

Answer 254

In infancy, with marked cardiomegaly, hypotonia, macroglossia, hepatomegaly, and normal glucose levels

Answer 255

Deficiency of acid alpha glucosidase. Can't break down the small amount of glycogen that ends up in the lysosome--> pathologic accumulation of glycogen within liver and muscle lysosomes

Answer 256

Carcinoembryonic antigen

Answer 257

Low dose: D1 receptors on renal vasculature--> ^GFR, ^RBF, ^Na excretion Medium: Stimulates Beta-1 in the heart--> ^cardiac contractility, pulse pressure, and systolic BP High: Stimulates alpha-1 in systemic vasculature--> vasoconstriction --> v Cardiac output due to the increased afterload

Answer 258

Cavernous hemangioma Enlargement caused by ectasia, cavernous, blood-filled spaces of various size lined by a single epithelial layer DO NOT BIOPSY- can cause fatal hemorrhage

Answer 259

pain and deformity of long bones, hearing loss due to bony deformity of the skull

Answer 260

Very large and can have up to 100 nuclei

Answer 261

IgA antibodies against gliadin cross-react with epidermal transglutaminase, causing microabscesses containing fibrin and neutrophils at the dermal papillae tips

Answer 262

increased intraepithelial lymphocytes, variable loss of villus height, and crypt hyperplasia

Answer 263

1. Negatively by binding of the repressor protein to the operator locus 2. Positively by cAMP-CAP binding upstream from the promoter region

Answer 264

intranuclear inclusions in both keratinocytes and multinucleated giant cells Acantholysis (loss of intracellular connections) of keratinocytes and intraepidermal vesicles

Answer 265

Tennis elbow- due to repetitive microtrauma to the extensor carpi radialis brevis Restricts wrist extension

Answer 266

ptosis (levator palpebrae) down and out gaze fixed, dilated pupil

Answer 267

pale retina and a cherry-red macula

Answer 268

Thayer-Martin: a chocolate agar based medium with various antibiotics- vancomycin to kill gram +, Colistin to kill gram -, nystatin to kill yeast, and TMP to inhibit the proteus species

Answer 269

GI: bloody diarrhea, risk for intussusception Kidney: same as IgA nephropathy- mesangial proliferation and crescent formation Skin: purpura on butt and lower extremities Joints: migratory arthralgias- mostly LE

Answer 270

a fusion protein with constitutive protein kinase activity

Answer 271

intestinal obstruction- due to compression by the adhesive bands Midgut volvulus-twisting around blood vessels-->ischemia

Answer 272

disruption of cell membranes | Denaturation of protein

Answer 273

disruption of cell membranes | coagulation of cytoplasm

Answer 274

halogenation of proteins and nucleic acids

Answer 275

``` Joint pain O- Endocarditis Nodules, subcutaneous Erythema marginatum Sydenham Chorea ```

Answer 276

Calcium-sensing receptors- transmembrane G-protein-coupled receptors Familial hypocalciuric hypercalcemia

Answer 277

irreversibly bind to penicillin-binding proteins that normally act as transpeptidases and cross-link peptidoglycan in the cell wall

Answer 278

Villous: large and sessile with cauliflower-like projections, more malignant transformation Tubular: form tubes, smaller, and pedunculated

Answer 279

secretory diarrhea, hypovolemia, electrolyte abnormalities

Answer 280

Metronidazole, vancomycin, or fidaxomicin Recurrent: Fidaxomicin- lower recurrence rate, lesser effect on normal colonic flora. Macrocyclic antibiotic that inhibits RNA pol

Answer 281

abnormalities of lymphatic outflow- swelling decreases with age

Answer 282

Immune dysregulation leading to overproduction of glomerular permeability factor, a cytokine which damages podocytes and decreases the anionic (negative) properties of the basement membrane

Answer 283

JAK-STAT | Release of IGF-1 which binds to receptor kinase and stimulates growth of bone, cartilage, muscle, and other tissues

Answer 284

transcription factors that bing to regulatory regions on DNA, altering the expression of genes involved in segmental organization of the embryo 180 nucleotides

Answer 285

rapidly progressive dementia and myoclonic jerks

Answer 286

Watershed areas: splenic flexure and rectosigmoid junction

Answer 287

Agenesis of the sacrum and occasionally lumbar spine- flaccid paralysis of legs and urinary incontinence. Maternal Diabetes

Answer 288

Activated macrophages express 1 alpha hydroxylase, which is used in the conversion to active vitamin D--> increased intestinal absorption of Ca, independent of PTH

Answer 289

Inferior epigastric arteries, because there is supporting posterior rectus sheath

Answer 290

decreases end plate potential

Answer 291

TX for MG is cholinesterase inhibitor--> excessive activation of both nicotinic and muscarinic acetylcholine receptors Scopolamine selectively antagonizes the muscarinic receptors

Answer 292

Ferrochelatase and d-aminolevulonic acid dehydratase

Answer 293

1. Melanoma- pigmentation | 2. Glomus tumor- modified smooth muscle cells of the glomus body, which shunts blood from skin surface in cold temps

Answer 294

posterior midline of the anal verge due to the poor perfusion of the posterior anal canal

Answer 295

If weight loss doesn't work, give her an estrogen receptor modulator to induce ovulation- clomiphene or letrozole

Answer 296

cataracts, rarely pseudotumor cerebri

Answer 297

Galactose-1-PO4 uridyl transferase Galactose-1-PO4 jaundic, vomiting, hepatomegaly, E Coli sepsis, cataract, hemolytic anemia

Answer 298

1. APC - responsible for regulating cell growth/adhesion | 2. K-RAS (unregulated proliferation), DCC (avoidance of apoptosis), p53 (regulates cell cycle)

Answer 299

DNA mismatch repair gene mutation--> microsatellite instability pathway

Answer 300

Suspicious, distrustful, hypervigilant

Answer 301

prefers to be a loner, detached, unemotional

Answer 302

eccentric, odd thoughts, perceptions, and behaviors- superstitions

Answer 303

Disregard and violation of the rights of others

Answer 304

chaotic relationships, sensitivity to abandonment, labile mood, impulsivity, inner emptiness, self-harm

Answer 305

Dramatic, superficial, attention-seeking

Answer 306

grandiosity, lack of sympathy

Answer 307

avoidance due to fears of criticism an rejection

Answer 308

submissive, clingy, needs to be taken care of

Answer 309

rigid, controlling, perfectionistic

Answer 310

Raloxifene is an estrogen agonist in the breast and uterus | Tamoxifen is an agonist in bone and uterus--> increased risk for endometrial cancer

Answer 311

FasR- can have transmembrane portion spliced out in some cancers to evade apoptosis

Answer 312

P Fimbriae (fimbrial antigen)- allows adhesion to uroepithelium

Answer 313

LPS- macrophage activation--> widespread release of IL-1, IL-6, and TNF-alpha

Answer 314

K1 capsular polysaccharide- prevents phagocytosis and complement-mediated lysis

Answer 315

Verotoxin (shiga-like): inactivates 60s ribosomal subunit | Heat stable/labile enterotoxins: promote fluid electrolyte secretion from intestinal epithelial cells

Answer 316

Left: Left Renal vein Right: IVC

Answer 317

postpartum ovarian vein thrombosis- an example of septic pelvic thrombophlebitis

Answer 318

low: atypical cells only in the lower 1/3rd of the cervical epithelium high: atypical cells beyond the lower 1/3rd of the cervical epithelium

Answer 319

HBeAg- marker of viral replication and increased infectivity

Answer 320

GI bleeding | Excess dietary protein intake

Answer 321

alters GI flora to decrease intestinal production and absorption of ammonia

Answer 322

LPL and ApoC-II | Acute pancreatitis

Answer 323

LDL receptor, ApoB-100 | Premature coronary artery dz

Answer 324

ApoE--> chylomicron and VLDL remnants | Premature coronary artery dz

Answer 325

ApoA-V--> VLDL | increased pancreatitis risk

Answer 326

pigmented mucocutaneous macules and multiple hamartomatous polyps in the gastrointestinal tract. Progressive growth of hamartomas can lead to ab pain and GI bleeding

Answer 327

liposarcomas are pleiomorphic causing scalloping of the nuclear membrane

Answer 328

epidermal, intercellular IgG and C3 depositis in a netlike or chickenwire pattern

Answer 329

anterior lobes and cerebellar vermis--> gait ataxia, truncal instability, intention tremor

Answer 330

causes nephrogenic diabetes insipidus- Interferes with the action of vasopressin on the renal collecting ducts

Answer 331

Meckel's diverticulum with heterotopic mucosa--> gastric mucosa can release H+ and eat through the intestine- BLEEDING

Answer 332

lengthening of right ventricular ejection time- right bundle branch block, pulmonary stenosis, and PAH

Answer 333

Cyclosporine and tacrolimus Afferent and efferent arteriolar vasoconstriction leading to a dose-dependent rise in BUN, Creatinine, and HTN. Long term use can eventually lead to obliterative vasculopathy

Answer 334

Metoclopramide- dopamine receptor antagonism can cause de novo parkinsonian symptom and extrapyramidal reaction

Answer 335

homogentisic acid dioxygenase- part of the degradation pathway for phenylalanine ad tyrosine

Answer 336

urine that turns black on exposure to air blue-black pigment deposition- nose, eyes, ears Ochronotic osteoathropathies

Answer 337

In the midbrain just deep to the corticobulbar tract in the cerebral peduncle

Answer 338

alpha synuclein filaments (eosinophilic inclusions)

Answer 339

Amniotic fluid is added to several wells with different concentrations of ethanol and shaken. The foam stability index is the highest value well that contains a ring of foam

Answer 340

Serum levels of LH and GnRH decline, leading to an estrogen deficiency--> infertility, vaginal atrophy, breast atrophy, osteopenia

Answer 341

Homocystinuria has INTELLECTUAL DISABILITY, HYPERCOAGULABILITY, and downwardly displace lens Marfans is upwardly displaced

Answer 342

Cystathione-beta-synthase | Builds up methionine and homocysteine

Answer 343

pili that bind to host epithelia cells and undergo phase and antigenic variation

Answer 344

muscle glycogen phosphorylase (myophosphoyrylase)

Answer 345

Lymphocytes infiltrate the orbital tissues and secrete cytokines--> fibroblast secrete increasing amounts of glycosaminoglycans (hyaluronic acid)--> extraocular muscle edema

Answer 346

modulates circadian rhythms, secreting melatonin in response to darkness or sympathetic stimulation

Answer 347

1. HA, N/V due to obstruction of cerebral aqueduct | 2. Parinaud syndrome- upward gaze palsy, absent pupillary reflex, impaired convergence

Answer 348

crypts of lieberkuhn

Answer 349

external radiation to the head and neck

Answer 350

Amygdalae Inappropriate sexual acivity, oral fixation, hyperphagia, placidity, amnesia Associated with HSV-1 encephalitis

Answer 351

Activated calcineurin dephosphorylates NFAT, which binds to an IL-2 promoter

Answer 352

Can't make NE or Epinephrine--> postural hypotension, exercise intolerance, nasal congestion, and ejaculatory difficulties

Answer 353

eosinophilic cytoplasmic inclusions in hippocampal neurons(negri bodies) also causes pharyngeal muscle spasms, hydrophobia, and ascending paralysis

Answer 354

Inhibits intestinal lipase, leading to decreased fat absorption and modest weight loss Side fx: ab discomfort, flatulence, diarrhea

Answer 355

thickening of the glomerular basement membrane with pale non-staining spikes of immune complex deposits

Answer 356

Above dentate line: superior rectal vein--> inferior mesenteric vein--> portal venous system Below dentate line: middle and inferior rectal veins--> internal iliac vein--> systemic circulation

Answer 357

Insulin upregulates PFK2, which converts F6P to F2,6BP. F2,6BP then upregulates PFK1, which is the enzyme needed for the conversion of F6P to F1,6BP--> glycolysis

Answer 358

Glucagon activates F2,6BPase, which downregulates F2,6BP, leading to conversion of F1,6BP to F6P--> gluconeogenesis

Answer 359

alanine, valine, leucine, isoleucine, phenylalanine, tryptophan, methionine, proline, and glycine

Answer 360

III, IV, V1, V2, VI | On each side of the sella turcica

Answer 361

Mucormycosis- spreads through the valveless facial venous system to the cavernous sinus, where it can cause infection or thrombosis

Answer 362

mean +/- 1.96xSD/(n^.5)

Answer 363

Elevated tryptase levels- tryptase is relatively specific to mast cells

Answer 364

Multivalent antigen crosslinks multiple IgE antibodies, resulting in aggregation and activation of non-receptor tyrosine kinases

Answer 365

gene transcription- located ~25 bases upstream

Answer 366

anti-histidyl-tRNA synthetase

Answer 367

in the superomedial quadrant of the buttock

Answer 368

Fetal hemoglobin- mostly replaced by Hb A within the first 6 months

Answer 369

Look for nystagmus

Answer 370

opening in the abdominal oblique aponeurosis

Answer 371

opening in the transversalis fascia

Answer 372

stimulants- modafinil (1st line), amphetamines (2nd line) | scheduled naps

Answer 373

clindamycin or beta-lactam and beta lactamase inhibitor

Answer 374

rectal biopsy of the submucosa to look for ganglion cells (meissner)

Answer 375

Curling's ulcers: arise in the proximal duodenum- associated with severe trauma/burns Cushing's ulcer: arise in the esophagus, stomach or duodenum with intracreanial injury due to direct vagus nerve stimulation by the increased ICP--> Ach release--> hypersecretion of gastric acid

Answer 376

cytokines circulate in resopnse to infection, promote inflammatory response by netrophils--> capillary damage and leakage of protein and fluid into the alveolar space

Answer 377

``` Anticonvulsants that induce CYP450 Aromatase inhibitors Medroxyprogesterone GnRH agonists PPIs (decrease Ca absorption) Glucocorticoids Unfractionated heparin Thiazolidenediones ```

Answer 378

inside macrophages

Answer 379

say the months of the year backwards

Answer 380

fetal squamous cells and mucin in the maternal pulmonary arteries

Answer 381

failure of recanalization, associated with Downs

Answer 382

Vascular occlusion in utero leading to ischemia with subsequent narrowing (stenosis) or obliteration (atresia). The terminal ileum spirals around an ileocolic vessel

Answer 383

Fructose Sorbitol dehydrogenase retina, lens, kidney, and peripheral nerves

Answer 384

cuboidal or polygonal cells with clear abundant cytoplasm eccentric nuclei. Grossly yellow due to high glycogen and lipid content Arises from proximal renal tubules

Answer 385

GDP is exchange for GTP on alpha subunit and it dissociates and activates Phospholipase C, which breaks PIP2 into IP3 and DAG. DAG directly activates Protein Kinase C, IP3 activates it by increasing intracellular Ca

Answer 386

TATA box: 25 bases upstream CAAT box: 70-80 bases upstream promote initiation of transcription by acting as binding sites for transcription factors and RNA pol II

Answer 387

Gram neg. bacilli (E Coli) | S. Aureus

Answer 388

Opening the nAChR allows influx of sodium and Potassium release. Those with burns, myopathies, crush injuries, and denervating injuries or disease upregulate the number of muscle nACHRs, resulting in release of large amounts of K

Answer 389

Elevated PT or bilirubin levels, hypoalbuminemia

Answer 390

neural tube defects, orofacial clefts, microcephaly, nail or digit hypoplasia

Answer 391

Ebstein anomaly, nephrogenic DI, hypothyroidism

Answer 392

Neural tube defects

Answer 393

microcephaly, thymic hypoplasia, small ears, hydrocephalus

Answer 394

limb and craniofacial abnormalities, neural tube defects

Answer 395

Renal dysgenesis, oligohydramnios

Answer 396

nasal hypoplasia, stippled epiphysis

Answer 397

appearance of vacuoles and phospholipid-containing amorphous densities

Answer 398

hypercellular glomeruli Electron dense deposits on the epithelial side of the basement membrane Coarse granular deposits of IgG and C3- "starry sky"

Answer 399

elevated anti-strep titers (anti-SLO, Anti-DNase B, anti-cationic proteinase) Low C3 Possibly cryoglobulins

Answer 400

GnRH agonist- constitutive activation--> downregulation

Answer 401

decreases synthesis of steroid hormones in the gonads and adrenals

Answer 402

Competitive testosterone receptor inhibitor

Answer 403

flank pain, gross hematuria, elevated LDH, left-sided varicocele

Answer 404

pulmonary edema

Answer 405

In the periportal granulocytes, there will be intracellular granules of unsecreted AAT that stain reddish-pink with PAS and resist digestion by diastase

Answer 406

Removal of introns by spliceosome, which consists of snRNPs (target of anti-smith) and other proteins

Answer 407

Pyruvate dehydrogenase (pyruvate-->acetyl coA) NADH, can't be converted back to NAD by electron transport chain Lactate, because lactate dehydrogenase can regenerate NAD

Answer 408

Mutation in the bruton tyrosine kinase gene cause failure of bone marrow pre-B to mature

Answer 409

The sternum, clavicle, and mastoid | superiorly and posteriorly

Answer 410

inferiorly and laterally

Answer 411

fever, back or flank pain, inguinal mass, difficulty walking Pain with psoas muscle stretch (extension of hip) Will position for minimum discomfort- hip flexion and lumbar lordosis

Answer 412

CSF in the subarachnoid space is continuous with the optic nerve sheath and the external pressure compresses the nerve externally, leading to impaired axoplasmic flow within the optic nerve

Answer 413

ducts distended by pleomorphic cells with prominent central necrosis that does not extend through he basement membrane

Answer 414

administration of hydrophilic bile acids to make cholesterol more soluble and promote gallstone dissolution

Answer 415

primary CNS lymphoma- dense, cellular aggregates of uniform, atypical lymphoid cells Associated with EBV

Answer 416

Histone 1- binds the linker segments of DNA that lie between the nucleosomes (nucleosome composed of 2 each of Histone 2A, 2B, 3, 4)

Answer 417

Lancinating pains, loss of vibratory and position sensation, areflexia, and a neurogenic bladder with overflow incontinence Argyll Robertson pupils: small pupils that don't constrict to light, but do for accomodation

Answer 418

Erosions do not fully extend through the muscularis mucosa, whereas ulcers extend through and into the submucosa

Answer 419

Abdominal aorta>coronary arteries>popliteal arteries>internal carotids>circle of willis

Answer 420

Increased cleavage of C2 and C4--> inappropriate activation of the complement cascade Increased conversion of kininogen to Bradykinin--> potent vasodilation asscoiated with angioedema

Answer 421

Erythrocytes: don't have mitochondria Liver: Lacks succinyl CoA-acetoacetate CoA tranferase (thiophorase)

Answer 422

Fructose- metabolized by the lier fastest and rapidly cleared from the serum

Answer 423

Tamoxifen is a prodrug metabolized to endoxifen by CYP2D

Answer 424

Look for where the 3 ribbons of the teniae coli converge at the root of the vermiform appendix

Answer 425

In the posterior rostral pons near the lateral floor of the fourth ventricle Norepinephrine

Answer 426

S3- high regurgitant volume and left ventricular volume overload

Answer 427

pancreatic tail, body, most of the head, and the small accessory pancreatic duct

Answer 428

uncinate process, proximal portion of the main pancreatic duct

Answer 429

Hepatocytes must be coated in the hep B surface antigen before it can infect hepatocytes and multiply

Answer 430

Clue cells- epithelial cells covered with gram variable rods

Answer 431

Renal compensation with loss of bicarb takes 24-48 hrs

Answer 432

diphtheria antitoxin (passive immunization) PCN or erythromycin DPT vaccine

Answer 433

erythrocyte rouleaux formation, bence-jones proteins in the urine, and an M peak showing excessive monoclonal immunoglobulin

Answer 434

normochromic, normocytic anemia lytic bone lesion hypercalcemia AL amyloidosis

Answer 435

5': GU | 3': AG

Answer 436

pancreatic lipase

Answer 437

propanolol, nadolol | Non-cardioselective beta blockers- can trigger bronchospasm

Answer 438

Beta 1 | metoprolol, atenolol, bisoprolol, nebivolol

Answer 439

Beta 1 cardioselective (metoprolol, atenolol, bisoprolol, nebivolol) Combined beta and alpha (carvedilol, labetalol)

Answer 440

Circulating immune complexes deposit in the glomerular capillary wall- looks similar to PSGN

Answer 441

mesangial hypercellularity with mesangial IgA deposits on immunohistochemical staining

Answer 442

pancarditis | Severe mitral regurgitation and/or myocarditis can lead to hrt failure and death in some pts

Answer 443

failure to thrive, cognitive defects, coarse facial features, corneal clouding- typically fatal in childhood

Answer 444

Defective phosphotransferase enzyme in the golgi body- there is no phosphorylation of mannose residues on lysosome bound proteins--> extracellular secretion of these proteins and accumulation of cellular debris in the lysosome

Answer 445

trabecular thinning with fewer interconnections

Answer 446

unmineralized osteoid

Answer 447

increased resorption of cortical bones and subperiosteal thinning

Answer 448

mosaic pattern of lamellar bone connected by cement lines

Answer 449

persistence of primary, unmineralized spongiosa in the medullary canals

Answer 450

Strengthening of the pelvic floor muscles- levator ani

Answer 451

Loss of upper motor neuron inhibition of spinal stretch reflex arc

Answer 452

polyarthralgias

Answer 453

``` Suprarenal glands Aorta and IVC Duodenum (not 1st part) Pancreas (head and body) Ureters and bladder Colon (ascending and descending) Kidneys Esophagus Rectum ```

Answer 454

Accumulation of hep B surface antigen within infected hepatocytes, giving a finely granular, diffusely homogenous, pale eosinophilic cytoplasm

Answer 455

Estrogen increases cholesterol synthesis | Progesterone reduces bile acid secretion and slows gallbladder emptying

Answer 456

Yellow- negatively birefringent

Answer 457

Squamous cell cancers Renal and Bladder Ovarian and endometrial Breast cancer

Answer 458

All Lymphomas

Answer 459

nonspecific nontreponemal serologic test in which pt serum is mixed with cardiolipin, lecithin, and cholesterol to look for aggregation.

Answer 460

Tc-pertechnetate scan

Answer 461

At higher risk for intussusception

Answer 462

in erythrocyte precursors in the bone marrow | blood group P antigen (gloroside)

Answer 463

Secretory proteins, integral membrane proteins (nucleus and cell membrane), proteins within the ER, golgi network and lysosome

Answer 464

Opioids- either in isolation or with co-ingestants

Answer 465

subdural hemorrhages due to tearing of the bridging veins, retinal hemorrhages due to rupture of congested retinal veins, posterior rib fractures

Answer 466

apathy and depression

Answer 467

disinhibited behavior

Answer 468

stimulant drugs (methylphenidate, amphetamines) increase NE and DA release from vesicular storage sites and block their reuptake at synapses in the prefrontal cortex

Answer 469

unilateral visual disturbances | severe hypertension--> fibrinous necrosis

Answer 470

atherosclerosis, cardioembolic disease, or vasculitis (giant cell arteritis)

Answer 471

GI and GU, most commonly gastric adenocarcinoma

Answer 472

The two major inactivation pathways for azathioprine and 6-MP are thiopurine methyltransferase and xanthine oxidase- allopurinol blocks xanthine oxidase, causing more to be converted to active 6-thioguanine

Answer 473

Naltrexone blocks the mu opiod receptor- alcohol becomes less rewarding

Answer 474

microvesicular steatosis- the presence of small fat vacuoles in the cytoplasm of hepatocytes. No necrosis or inflammation EM- swelling and a decreased number of mitochondria and glycogen depletion

Answer 475

Inhibits presynaptic reuptake of monoamines (NE, DA, 5HT)

Answer 476

Paradoxical aPTT prolongation Anticardiolipin ab anti-beta2-glycoprotein-I ab

Answer 477

Increased production or decreased outflow of aqueous humor--> elevated intraocular pressure Timolol and other nonselective beta blockers diminish secretion of aqueous humor by the ciliary epithelium

Answer 478

pyrogenic exotoxins from group A strep. Usually associated with strep pharyngitis

Answer 479

pruritic skin rash and arthralgias 7-14 days after exposure to an antigen. Histology: small vessel vasculitis with fibrinoid necrosis and intense neutrophil infiltration

Answer 480

Type III --> hypocomplementemia | antigenic heterologous proteins such as chimeric monoclonal abs or nonhuman immunoglobulins

Answer 481

Meningococcal septicemia causes bilateral hemorrhagic infarction of the adrenal glands

Answer 482

Alpha-2 adrenergic and somatostatin 2

Answer 483

M3, Beta-2 adrenergic receptor, and Glucagon-like peptide-1

Answer 484

hypoglycemia, hepatomegaly, ketoacidosis, muscle weakness, hypotonia

Answer 485

Infundibulopelvic (suspensory) ligament

Answer 486

Conversion of pyruvate to oxaloacetate by pyruvate carboxylase (biotin-dependent)

Answer 487

Thionamides (propylthiouracil and methimazole) can cause agranulocytosis Get WBC with differential

Answer 488

Peptostreptococcus, prevotella, bacteroides, and fusobacterium- orral anaerobe involved in aspiration pneumonia

Answer 489

Koplik spots, conjunctivitis, fever, cough, rinorrhea

Answer 490

Congenital: dysfunction of ganglion cells of the myenteric plexus T. Cruzi: Neurotoxin destroys myenteric plexus and causes parasympathetic denervation of smooth muscle

Answer 491

Recombination- gene exchange through the crossing over two dsDNA molecules

Answer 492

Excessive matrix metalloproteinase activity and myofibroblast accumulation in the wound margins

Answer 493

cyproheptadine- a 5HT1A and 5HT2A antagonist

Answer 494

high molecular weight, high plasma protein binding, high charge, and hydrophilicity

Answer 495

Depolarizes cellular membrane by creating transmembrane channels

Answer 496

Myopathy and CPK elevation

Answer 497

red man syndrome | nephrotoxicity

Answer 498

Cox-2 inhibitors such as aspirin

Answer 499

Can cause contraction of smooth muscle cells in the sphincter of oddi--> increased pressure in the common bile duct--> biliary colic

Answer 500

Primary hyperparathyroidism Pituitary tumors Pancreatic Tumors

Answer 501

Medullary thyroid carcinoma Pheochromocytoma Parathyroid hyperplasia

Answer 502

Medullary Thyroid Carcinoma Pheochromocytoma Mucosal Neuromas/Marfanoid habitus

Answer 503

PT, bilirubin, albumin, cholesterol

Answer 504

transaminases

Answer 505

alkaline phosphatase, gamma-glutamyl transpeptidase- need both to determine if elevated alk phos is from hepatic or bony origin

Answer 506

persisten connection between the scrotum and the peritoneal cavity through the inguinal canal- Small opening- only liquid can get through-->hydrocele Large- indirect inguinal hernia

Answer 507

watery diarrhea, hypokalemia, and achlorhydria

Answer 508

stimulates pancreatic bicarbonate and chloride secretion. | Also, binds epithelial cells--> ^cAMP--> Na, Cl, and H2O secretion into the bowel

Answer 509

VIP Gastrin Glucagon Cholecystokinin

Answer 510

Classic galactosemia- AR absence of galactose-1-phosphate uridyl transferase Very severe- presents within days with jaundice, vomiting, and hepatomegaly

Answer 511

play an important role in mRNA translation regulation and mRNA degradation

Answer 512

Glycerol kinase to get to glycerol 3-phosphate, then glycerol 3-phosphate dehydrogenase to get to DHAP which can be used for gluconeogenesis

Answer 513

premature or those with cyanotic congenital hrt dz

Answer 514

monosaccharides

Answer 515

Weakness of the transversalis fascia | Medial to the inferior epigastric vessels

Answer 516

swollen knee, focal patella tenderness, and inability to extend the knee against gravity (quads insert on the superior pole of the patella)

Answer 517

strep pneumo, S aureus, and H flu

Answer 518

absence of CD 18 antigens--> recurrent infections that lack purulence, leukocytosis, late separation of umbilical cord

Answer 519

phentolamine, phenoxybenzamine (non-selective alpha)

Answer 520

alpha 1-blockers: doxazosin, prazosin, and terazosin | relaxation of smooth muscle in the vasculature and in the bladder neck and prostate

Answer 521

Elderly person with one or more of the following: 1. Fatigability (anemia) 2. Constipation (hypercalcemia) 3. Bone pain 4. Elevated serum protein 5. Renal failure

Answer 522

Excess excretion of free light chains (Bence Jones proteins) exceed reabsorptive capacity and precipitate to form casts that cause tubular obstruction and epithelial injury. light Microscopy: glassy casts that stain eosinophilic

Answer 523

Pituitary hemorrhage- can be differentiated from SAH by the presence of bitemporal hemianopsia

Answer 524

Cardiovascular collapse due to ACTH deficiency | Give glucocorticoids and consult neurosurgery urgently

Answer 525

Acute inflammation of the gallbladder in the absence of gallstones- usually in critically ill pts due to gallbladder stasis and ischemia

Answer 526

They are DNA binding receptors located in the nucleus

Answer 527

They are DNA binding receptors located in the cytoplasm that go to the nucleus after binding

Answer 528

It interacts with the JAK-STAT pathway (no intrinsic tyrosine kinase activity)

Answer 529

located on the cell membrane- have intrinsic tyrosine kinase activity, so ligand binding leads to autophosphorylation

Answer 530

Dry: chronic oxidative damage to retinal pigment epithelium and choriocapillaris -->drusen deposits

Answer 531

Wet: Excessive extracellular matrix accumulation--> retinal hypoxia--> ^VEGF--> neovascularization with leaky vessels-->fundoscopy showing gray-green subretinal discoloration with adjacent fluid/hemorrhage

Answer 532

Dry and wet: antioxidant vits and zinc, smoking cessation | Wet only: VEGF inhibitor

Answer 533

Excessive insulin dose Inadequate food intake Exercise

Answer 534

Visceral adenocarcinoma of the pancreas, colon, or lung Hypercoagulability due to tumor production of a thromboplastin-like substance that can cause chronic intravascular coagulations

Answer 535

Acyl CoA dehydrogenase deficiency | hypoketotic hypoglycemia- need to break down FAs to make ketone bodies- can be asymptomatic until a significant fast

Answer 536

It has no direct cytotoxic effect. Instead, it induces cytotoxic T cells to destroy the infected hepatocytes The antigen-Ab ICs can lead to extrahepatic damage- arthralgias, urticaria, glomerulonephritis, cryoglobulinemia, vasculitis

Answer 537

An antidiarrheal agent similar to meperidine that binds to mu opiate receptors in the GI tract and slows motility Overuse can lead to euphoria, so it is often combined with atropine to induce adverse effect if taken in high doses

Answer 538

The pons at the level of the middle cerebellar peduncle

Answer 539

``` corticospinal tract (contralateral hemiparesis) Corticobulbar tract (contralateral lower facial palsy) ```

Answer 540

Block ENaCs on the apical side of the principal cells- potassium sparing

Answer 541

spotty necrosis with ballooning degeneration, councilman bodies (eosinophilic apoptotic hepatocytes), and mononuclear cell infiltrates

Answer 542

1. SPINK1 deficiency: normally secreted by pancreatic acinar cells- trypsin inhibitor 2. Formation of abnormal trypsin that is not susceptible to inactivating cleavage by trypsin

Answer 543

phrenic nerve (C3-C5) irritation and palsy.

Answer 544

Accumulation of monoclonal immunoglobulin light chains- seen as eosinophilic extracellular deposit in H&E Apple-green birefringence with congo red under polarized light

Answer 545

T cell | SVC syndrome, dysphagia (esophageal compression), dyspnea and stridor (trachea compression)

Answer 546

lip: failure of fusion of the maxillary prominence with the intermaxillary segment palate: failure of fusion of the palatine shelves with one another or with the primary palate

Answer 547

Defective hepatic secretion of bilirubin glucuronides across the canalicular membrane, resulting in direct (conjugated) hyperbilirubinemia and jaundice

Answer 548

Excess NH3 in the blood is absorbed by astrocytes, which combine it with glutamate to make glutamine--> This builds up, causing astrocyte hyperosmolarity and cellular swelling--> decreased release of glutamine that can be converted to glutamate in the neurons

Answer 549

Slow onset of action, because it takes more anesthetic to saturate the blood and then the brain

Answer 550

transverse carpal ligament (flexor retinaculum)

Answer 551

Vascular smooth muscle Platelet-derived growth factor from locally adherent platelets, dysfunctional endothelial cells, and infiltrating macrophages stimulates VSMC migration and proliferation

Answer 552

Production of UDP glucuronyl transferase

Answer 553

calcification of the rim of the hilar nodes and birefringent silica particles surrounded by fibrous tissue on histology

Answer 554

lysine and leucine

Answer 555

Vitamin A | Measles can deplete vitamin A, causing keratitis and corneal ulceration

Answer 556

Cyanide toxicity | altered mental status, seizures, CV collapse, lactic acidosis, bright red venous blood

Answer 557

Binds to Fe3+ in cytochrome c oxidase and halts electron transport chain in the mitochondria

Answer 558

Sodium nitrite--> methemoglobin formation, which binds the cyanide Sodium thiosulfate--> donates sulfur to convert cyanide to thiocyanate, which can be excreted in urine Hydroxocobalamin--> cobalt binds cyanide and forms cyanocoblamin--> excreted in urine

Answer 559

Rhodanese- donates a sulfur molecule to convert it to thiocyanate that can be excreted in the urine

Answer 560

The capsule prevents phagocytosis and intracellular killing by neutrophils

Answer 561

cognitive impairment, irritability constipation, abdominal pain interstitial nephritis anemia

Answer 562

CA-125 (psamomma bodies)

Answer 563

b-hCG (fried egg cells)

Answer 564

AFP (Schiller-Duval bodies: look like glomeruli)

Answer 565

Increased estrogen and inhibin (call-exner bodies, coffee bean nuclei)

Answer 566

increased androgen

Answer 567

BRAF- V600E (valine--> glutamic acid) protein kinase involved in activation of signaling pathways for melanocyte growth, survival, and metastasis TX: Vemurafenib

Answer 568

Mutations inhibit the extrinsic pathway of apoptosis of autoreactive lymphocytes

Answer 569

Normally, Ca and oxalate bind in the intestine and are released in fecal matter. In Crohn's bile acids are not recycled so there is excess fat, which binds the Ca, so more oxalate is absorbed and turned to stone

Answer 570

disables 60s ribosomal subunit and halts protein synthesis

Answer 571

perifollicular hemorrhages, myalgias, subperiosteal hematoma, and gingivitis

Answer 572

1. reduce myocardial contractility and HR | 2. Decrease renin release by kidney

Answer 573

Shrinkage of the cell body Pyknosis of the nucleus Loss of Nissl Substance Eosinophilic cytoplasm

Answer 574

Enlargement of the cell body Eccentric nucleus Enlargement of the nucleolus Dispersion of the Nissl substance

Answer 575

Loss of neurons and functional groups of neurons | Reactive gliosis

Answer 576

Aortic regurgitation

Answer 577

Intramuscular glucagon

Answer 578

Clot within the splenic vein (pancreatitis, pancreatic cancer)

Answer 579

Posterior Descending artery which supplies blood to the AV node via the AV nodal artery

Answer 580

initial embryonic disturbance leads to multiple malformations

Answer 581

Theca cells stimulated by LH | Granulosa cells stimulated by FSH

Answer 582

collection of squamous cell debris that forms a pearly mass behind the tympanic membrane. Can lead to otorrhea and eventually conductive hearing loss due to erosion of the ossicles

Answer 583

The 2nd part | The 3rd part

Answer 584

phenoxybenzamine

Answer 585

skin Superficial cervical fascia (including platysma) investing and pretracheal layers of the deep cervical fascia Cricothyroid membrane

Answer 586

t1/2= (0.7 x Vd)/CL

Answer 587

Seizures and Tachyarrhythmias

Answer 588

Leukocyte alkaline phospatase- normal or elevtaed in leukemoid reaction, but decreased in CML

Answer 589

spongiosis: an accumulation of edema fluid in the intercellular spaces of the epidermis

Answer 590

cornea and basal ganglia | d-Penicillamine and trientine- chelators

Answer 591

multiple wedge-shaped hemorrhagic lesions in the periphery of the lung. Hemorrhagic due to the dual blood supply

Answer 592

Gluconeogenesis: Pyruvate to ocaloacetate (pyruvate carboxylase) FA synthesis: Acetyl-CoA to Malonyl CoA (acetyl-CoA carboxylase) FA oxidation: Propionyl CoA to methylmalonyl CoA (Propionyl-CoA carboxylase)

Answer 593

Invasive squamous cell carcinoma

Answer 594

bone pain, renal stones, GI issues (peptic ulcer dz), and psychiatric disorders

Answer 595

Subperiosteal thinning with subperiosteal erosions in the phalanges on radiography and osteolytic cysts in the long bones

Answer 596

Tuberculoid: appropriate cell mediated response by Th1 Lepromatous: Humoral response by Th2

Answer 597

VEGF and FGF

Answer 598

When sodium channels are in their inactiated state. Because ischemic myocardium is at a higher resting potential, they are inactivated for longer, so class Ib is more selective for ischemic myocardium than normal myocardium

Answer 599

Secretory IgA- impairs adherence

Answer 600

intrahepatic, interlobular ducts destroyed by granulomatous inflammation. pruritis, fatigue --> jaundice, pale stools, dark urine, hypercholesterolemia

Answer 601

At first, it is distributed to organs that receive high blood flow, like the brain. After time, it is redistributed to other organs, so the effect on the brain is terminated

Answer 602

segmental, transmural inflammation of the arterial wall with fibrinoid necrosis

Answer 603

Most commonly- kidney, heart, GI, and liver, but can affect any organ other than the lungs

Answer 604

Mismatched: 3' to 5' exonuclease | RNA Primers: 5' to 3' exonuclease

Answer 605

Extension, adduction, and internal rotation of the humerus | Thoracodorsal

Answer 606

reduction in mitochondria and RER

Answer 607

Patients with chronic diarrhea have reduced absorption of bicarb from the gut. This leads to metabolic acidosis and increased renal H+ excretion, causing conversion of soluble urate salts into insoluble uric acid

Answer 608

Strep pneumo

Random Flashcards

(658 cards)